| NPI | 1568781573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA09058400) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 257385) |
| Enumeration Date | 2010-06-01 |
| Last Update Date | 2013-03-22 |